ACR Codes: 4.9
Charcot joint can be broken down into sequential steps.
1. Loss of deep sensation and proprioception: Central and peripheral lesions can lead to neuropathic osteoarthropathy. Central lesions include syphilis, syringomyelia, meningomyelocele, trauma, multiple sclerosis, Charcot-Marie-Tooth disease, congenital vascular anomalies, and other causes of cord compression, injury, or degeneration. Peripheral causes include diabetes mellitus, alcoholism, amyloidosis, infection, pernicious anemia, trauma, and intra-articular or systemic administration of steroids.
2. Recurrent injury: Any of the lesions mentioned above can lead to loss of sensation of the joint which then leads to abuse and progressive degeneration and disorganization of the joint.
3. Erosion of chondral surface, subchondral sclerosis, fracture, fragmentaion: From the recurrent abuse/injury there is osseous and cartilaginous destruction which becomes more extensive, and the embedded pieces of cartilage and bone produce local synovial irritaion. Bony malalignment and subluxation eventually occurs.
4. Joint disorganization: Eventually, large portions of the chondral coat are lost, sclerosis is extreme, capsular rupture can occur, and shards of bone can dissect along the soft tissue planes.
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Disease Topic 4954 
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